EFFECT OF PHYSICIAN PROFILING ON UTILIZATION - METAANALYSIS OF RANDOMIZED CLINICAL-TRIALS

OBJECTIVES: An American medical Association survey reported that more than half of physicians are subjects of either clinical or economic pr ofiling. This multilevel meta-analysis was designed to assess the clin ical effect of peer-comparison feedback intervention (profiles) in cha nging practice patterns. METHODS: Systematic computerized and manual s earches were combined to retrieve articles on randomized controlled cl inical trials testing profiling reports. Eligible studies were randomi zed, controlled clinical trials that tested peer-comparison feedback i ntervention and measured utilization of clinical procedures. To use al l available information, data were abstracted and analyzed on three le vels: (1) direction of effects, (2) p value ham the statistical compar ison, and (3) odds ratio (OR). MAIN RESULTS: In the 12 eligible trials , 553 physicians were profiled. The test result was p < .05 for the vo te-counting sign test of 12 studies (level 1) and p < .05 far the z-tr ansformation test of 8 studies (level 2). There were 5 trials included In the OR analysis (level 3). The primary effect variable in two Of t he 5 trials had a nonsignificant OR. However, the overall OR calculate d by the Mantel-Haenszel method was significant (1.091, confidence int erval: 1.045 to 1.136). CONCLUSIONS: Profiling has a statistically sig nificant, hut minimal effect on the utilization of clinical procedures . The results of this study indicate a need for controlled clinical ev aluations before subjecting large numbers of physicians to utilization management interventions.